Tag Archive for: weight loss

Fasting: Two Approaches

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It’s time to get into some real fasting. While there’s nothing wrong with the abstinence approach, abstinence is not really fasting. I’m going to cover two different approaches. The first is known by the moniker 5:2. That means you eat reasonably five days out of the week and you fast two days per week. The second is a straight fasting approach of limiting calories per day that has been used in conjunction with cancer treatment. There’s no specified times to eat in either case, and you can drink any calorie-free beverages of your choosing.

The 5:2 Fast

The 5:2 fasting diet was originally developed about 10 years ago by a British physician/journalist. It’s become commercialized over the years with new additions and materials but essentially, this is how it works:

  • For five days a week, you eat your normal diet. The goal is to eat healthier, but there are no restrictions on the number of calories that you can eat.
  • For two nonconsecutive days of the week, you reduce your caloric intake to 750 calories per day, spread out over the day as you want. Again, the goal is to eat healthy food—and wouldn’t you know it, healthy food is generally low in calories! Your intake should include plenty of vegetables.

That’s it. It’s a way you can eat for the rest of your life if you want to. If you add some exercise and choose a better diet, you could lose weight and get some of the benefits I talked about in earlier Memos.

The Two- to Five-Day Fast

This approach is closer to a true fast than anything else because there are no gimmicks. The goal is to help the immune system and other organs by focusing less on growth and more on repair. This approach was developed by Dr. Valter Longo and has the most research behind it.

The goal is to eat healthy. A vegetarian approach with very low protein can make it very beneficial. Because this is a very low calorie fast, you have to check with your physician before you do it. Here we go:

  • Day 1
    Eat up to 1,200 calories, primarily from vegetables with some protein. Soups and broths make this approach easier. If you wanted to use shakes or smoothies, that’s acceptable as long as you stay under the 1,200 calories for the day.
  • Day 2 through Day 5
    On these days, your calories are restricted: 300 to 500 calories per day. The calories should come primarily from vegetables and again soups and broths are desirable.

When I use this approach, I generally do two days: one 1,200 calorie day and one 500 calorie day, and then eat normally the other five days. You have to be mentally ready if you’re going to do additional days. Eat when you want, whether a single meal or spread throughout the day. The choice is yours.

The Bottom Line

The last four Memos have talked about fasting and abstinence in relation to food intake. The question is why do this at all? Is there science to support it? Is it worth doing? That’s for next week.

What are you prepared to do today?

        Dr. Chet

Fasting: Abstinence Models

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How did you do on your 18:6 abstinence from food if you tried it? The ratio of abstinence to eating can vary. I asked you to try an 18:6 approach. Personally, I did fine—that’s just about my normal eating pattern anyway. I’m going to give you one version of an abstinence model today. I’ll give you two versions of a fasting model on Saturday.

The objective was to avoid food for 18 consecutive hours. The clock begins after your last meal the evening before. If you like to eat late or go out with the gang, that means that you might finish eating at 10 p.m. You wouldn’t eat again until at least two o’clock the following afternoon. Then you would have six hours to eat, ending at 8 p.m., and then the cycle begins again. Just to be clear: you don’t start the clock on the six hours for eating until you actually take your first bite of food. That’s why your last meal might have been 10 p.m. on one day because you didn’t start eating until 4 p.m., because let’s face it things don’t always go to plan.

The question: what do you eat during those six hours? Everybody seems to have an opinion. You could use a ketogenic or Paleolithic approach or you could eat a Mediterranean diet. You could also stuff yourself with all kinds of junk food. Regardless of which approach you decide to use, the goal is to eat better for maximum benefit. You can drink any calorie-free beverages of your choosing.

I’ll give you two different approaches for a fasting plan on Saturday. Until then, if you haven’t tried it, see how you do, with the same proviso for people with serious medical disorders.

What are you prepared to do today?

        Dr. Chet

Fasting vs. Abstinence

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Before I talk about the differences between fasting and abstinence, I want to make it clear that I’m in favor of both approaches when used wisely. I don’t think either is the way you should eat for the rest of your life, but if you have specific objectives to control your weight or to reduce your risk of degenerative disease such as cardiovascular disease, type 2 diabetes, and even reduce your risk of cancer, I think they both can be beneficial. Let’s look at the pluses and minuses of each.

Definitions

Fasting is a controlled reduction in the number of calories eaten in 24 hours.

Abstinence is the complete avoidance of food within a given time frame, whether that’s complete days or specific hours of the day.

Pluses and Minuses: Fasting Versus Abstinence

The pluses:

Both fasting and abstinence take in fewer calories than the body needs, which can help with weight loss if sustained long enough.

Fasting can help you handle hunger because you’re eating something eventually.

Fasting can also force your body to deplete all glycogen stores, depending on the source of the calories.

Abstinence forces the body to use all storage forms of sugars; then it uses stored fat as a fuel, increasing the supply of ketones for fuel.

When fasting, calories can be manipulated during the day to ensure you can eat before exercise if it’s required.

With abstinence, no thinking is necessary; you don’t eat anything when you’re abstaining from food.

The minuses:

With abstinence, you’re taking in no calories, so hunger can become an issue.

If you need to eat before you exercise, abstinence will limit the time of day you can exercise.

When fasting, deciding what to eat and when to eat it requires planning; that can be challenging for some people while making life easier for others.

There are more pluses and minuses for each approach, but I think that these are the most significant upsides and potential downsides of each.

The Bottom Line

As I said at the beginning, I’m in favor of both approaches. They both have merits and challenges—the key is using them wisely.

Next week, I’m going to give you examples of abstinence and fasting and how to use them. In the meantime, give the abstinence approach a ride around the block. Don’t eat for 18 consecutive hours on Sunday or Monday (that includes the time you’re asleep, limiting your eating to just six hours; you get to decide whether to eat the first six or last six consecutive hours you’re awake.) You also get to decide what you’re going to eat. Don’t try it if you have a severe metabolic disorder such as type 1 or uncontrolled type 2 diabetes.

What are you prepared to do today?

        Dr. Chet

The Fasting Dilemma

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I hope you all had a wonderful Thanksgiving. Because we’ve entered the “weight-gain portal” time of the year, let’s talk about the fasting craze that some people are doing and the rest are thinking about trying. As I see it, the problem is the lack of clarity in terminology and subsequently the execution of a fasting program. Terms such as “5:2” and “16:8” are thrown around. What exactly is a fast? What can it do for a person? What’s the best way to do a fast?

The problem begins with defining the term “fast”; there’s no consistent way the term is used, and that includes in the methodology of research studies. Fasting can mean avoiding all food and in some cases drink. That definition can describe fasts done for religious purposes as well as the fasts talked about for weight loss and controlling metabolism.

Another definition of fasting is severely reducing calories; if you lower your intake from 2,000 to 1,400 calories to lose weight, that’s a fast. If you’re drastically reducing calories for two to four days to help reset your immune system, that’s also a fast. But if you’re not consuming any calories, whether for a specific number of hours per day or a whole day, that’s more accurately called “abstinence from food.” Is that a big deal? Yes, and I’ll explain why on Saturday.

What are you prepared to do today?

        Dr. Chet

Addressing the Systems of Health and Disease

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A systems approach to dealing with diseases and conditions is not what we currently do: if you have pain, you want to relieve the pain. That approach may fix the symptom, but it also may not fix the failure of a complex system that caused the problem. If you’ve broken a bone or had a torn ligament surgically repaired, that was not a system failure, but the approach to get things back to normal would be the same. Multiple systems would be involved, not just pain control.

To illustrate the point, I’m going to talk about one of the most complicated conditions: carrying too much body fat. It affects 70% of the population of the U.S. and is a growing problem around the world. My advice for dealing with it goes like this: Eat less. Eat better. Move more. Those recommendations really don’t change, but to permanently lose the weight and keep it off, the number of systems involved is staggering.

A Systems Overview of Obesity

Here are some of the questions yet to be answered about organs and systems that are involved in weight reduction:

  • What will happen to fat cells? The fat cells manufacture hormones that can impact appetite and hunger. At this point, there’s no research to suggest they’re ever reabsorbed.
  • The pancreas produces digestive enzymes and insulin. How will less food or different foods along with more exercise impact their involvement in digestion and metabolism?
  • Our taste buds have developed over the years. Will they change to reduce the taste and feel of sugar, fat, salt, and umami we may crave?
  • Can the impact of insulin on the liver change? Your liver develops a process to convert carbohydrate to fat and store it. Will that be reversed?
  • Will the adrenal gland respond to the decrease in fat intake and cholesterol production to reduce the production of cortisol and lower inflammation?
  • What happens to the microbiome in the long term? Does it adapt? Does it stimulate hunger or decrease it?

I could go on and on, but I think you get the point. It’s complicated to deal with complex systems. We don’t have the answers yet because we haven’t been asking the right questions.

The Impact of Aging on Complex Systems

We know as people age, we lose muscle mass, gain body fat, and lose bone density among many other changes. What we don’t know much about is the specific changes in every type of cell, organ, or system. If we don’t have that, we may not be able to address the correct cog in the system. That doesn’t mean we shouldn’t try; we can take what we currently know about how our bodies change over a lifetime and use that as a starting point. The earlier in life the better, but we still have to deal with individuals and the bodies they have right now.

We live a lot longer than we did 100 years ago. It’s time we began making those years better in every way rather than simply managing pain and other infirmities.

The Bottom Line

This challenge lies before us: Find a way to manage complex systems in order to not just survive but thrive throughout our entire lives. That’s where I’m headed in developing Aging with a Vengeance. We have to deal with the changes from aging that contribute to where we are today, regardless of age. Along the way, we’ll find out the optimal age for preventing some of those issues or at least slowing them down. I’m pumped for this journey to be the best version of ourselves, regardless of our current age or physical state. We just have to keep our heads in the game.

What are you prepared to do today?

        Dr. Chet

Aging with a Vengeance and Your Proteome

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This year’s Super Bowl Webinar focused on aging with a vengeance—becoming the best version of yourself, no matter your age. The study we just reviewed on the proteome suggests that the people were healthier who were biochemically younger than their actual age. Here are the actions I believe can help at the three critical phases of aging that were identified in proteome study. As I find out more, I’ll be more specific.

31 to 37

If you have weight to lose, now is the time to lose it. Take it from me and my decades of experience with weight loss programs: it becomes more difficult the older you get. Find a way to eat that will maintain a reduced body weight and stick with it.

Reduce your protein intake. That may seem a little odd, but this is a time to focus on vegetables, fruit, whole grains, and quality oils.

Focus on your cardiovascular system by doing aerobic exercise on a regular basis. Use interval training to make the most of your time, and when you’re fit enough, you can add high-intensity interval training (HIIT) to your routine.

57 to 63

The kind of 80- to 85-year-old you’re going to be is dependent on what you do now. If you haven’t achieved a normal body weight, that’s a high priority just as it was in the prior age group. I know how difficult this is because it’s eluded me throughout my life; I lost a lot of weight and kept it off for years, but I’d still like to weigh less.

Increase protein intake to 1–1.5 grams per kilogram body weight per day.

Supplement your diet with essential amino acids. While the amounts are still not absolutely clear from the research, 10–20 grams per day is a good goal.

If you’re not already doing so, add weight training to your exercise routine. Start with using your own body weight, then add exercise tubes or light weights, and then use machines or free weights. Now is the time to retain or even increase your muscle mass.

75 and Older

If you haven’t achieved a normal body weight, there’s still time. My wonderful mother-in-law lost a significant amount of weight at this age, and she was an overweight diabetic in a wheelchair.

Increase protein intake to 1.5–2 grams per kilogram body weight per day. It’s difficult because appetite decreases and protein makes us feel full. It will help reduce the muscle loss that’s happening.

Supplement your diet with essential amino acids; the amounts are still between 10–20 grams per day.

Add weight training to your exercise routine. It will help you to retain or even increase your muscle mass. Stay within any orthopedic or other limitations, and get some help if you need to, but do it. Your primary caregiver will probably be glad to refer you to a physical therapist who can get you started safely.

The Bottom Line

For all that’s been written about healthy aging, we still don’t know very much. Healthy aging begins the day we are born, but we realize that only when it dawns on us that we’re aging. No matter your age, no matter your current state of health, it can be better. You can learn more in the replay of this year’s Super Bowl Webinar, but it will be available for only a little while longer.

The simple things I’ve talked about in this Memo are a beginning. When I know more, so will you. Inevitably, it comes back to a single question:

What are you prepared to do today?

        Dr. Chet

Reference: Nature Medicine. 2019. https://doi.org/10.1038/s41591-019-0673-2

Obesity Game Changer?

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Obesity is a serious issue in the U.S. and around the world; type 2 diabetes, hypertension, CVD, and other diseases associated with obesity have significant health costs. That’s why a real game changer would be important to help people lose weight and maintain their weight loss. The latest candidate is semaglutide, an anti-diabetic medication used for the treatment of type 2 diabetes by increasing insulin secretion. In my opinion, the results of this study do not achieve game-changing status. Let’s take a look at the details.

There Was Limited Weight Loss

The mean weight loss was 14.9% which translated to 34 pounds in 68 weeks. That’s really not impressive; most people can lose a half pound a week by paying more attention to their diet and increasing their activity level. The rate of weight loss in the placebo group stabilized at about 20 weeks, and that’s where it stayed for the rest of the study. In the experimental group, the rate of weight loss declined twice; first at about 20 weeks and then again at 52 weeks. By 60 weeks, the experimental subjects did not appear to be losing any more weight.

The Lifestyle-Change Program Was Ineffective

With 35 years of experience in weight loss programs, my hunch is that by 20 weeks, both the placebo and the experimental group had reverted to their prior eating patterns. We don’t know for sure because no nutritional data were presented, but that would explain the lack of continued weight loss in the placebo group and slowing weight loss in the experimental group. The drug may be game-changing, but without permanent lifestyle changes, it’s just another weight loss drug.

The medication was effective in continuing weight loss in the experimental groups, but we don’t know how. Insulin is the most powerful hormone in the body, but we don’t know exactly how semaglutide helped these subjects lose weight. Did it influence appetite? Did it impact insulin levels alone?

At What Price?

The lowest price I could find with insurance coverage was $800 per month. This would be cost-prohibitive for most people. Another way of looking at: it cost $376 per pound of weight lost. I’m not sure that’s worth the price because we still don’t know if the drug will help maintain the loss for a significant period.

And besides the monetary cost, what physical cost did the drug have? Every drug has side effects. That’s why in most cases I recommend trying lifestyle changes before adding a medication; if unhealthy habits helped create the problem, changing those habits is the best place to start. Even if a healthier diet and increased activity don’t solve the problem, those changes may mean you can take a lower dose of the med, thus reducing side effects. Except in urgent cases, most doctors will give you some time to try lifestyle changes before adding a medication.

The Bottom Line

I consider the study a failure because the subjects in both groups never learned how to change their food intake and exercise behaviors. Yes, those people taking the pharmaceutical did better related to weight loss, and because of that, some metabolic factors improved. But the rate of weight loss slowed down as the study progressed and eventually appeared to stop. Maybe this drug will give some people an edge with initial weight loss and thus improve their odds of long-term success, but if they don’t permanently change their behaviors, they won’t permanently lose weight.

We have to quit thinking of a healthier diet as a temporary change. The challenge is not losing weight; the challenge is in maintaining the lost weight. If you go back to your old eating habits, you’ll go back to your old weight; if you won’t commit to changing your diet and activity, taking a pill isn’t going to help you for very long.

While interesting, this study doesn’t change the game. The game was, is, and always will be eat better, eat less, and move more. For life.

What are you prepared to do today?

        Dr. Chet

Reference: NEJM. 2021. DOI: 10.1056/NEJMoa2032183

“Game-Changing” Treatment for Obesity!

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If ever a health headline gets your attention, it’s one that proclaims there’s a better way to lose weight. “A game changer” said one of the principle authors of the study in a news release about the study. The results of any study that suggests “game-changing results” just has to be reviewed, and that’s what I’ll do in this week’s Memos.

The study was a trial of 1,961 subjects conducted at 129 sites around the world. The subjects were randomly assigned to the experimental group and placebo group in a 2:1 ratio. The experimental group received once-weekly injections of semaglutide, currently approved as a diabetes treatment, while the controls were injected with a placebo. Both groups received individual counseling sessions every four weeks to help them adhere to a reduced-calorie diet and increased physical activity. The study was 68 weeks long.

After 68 weeks, the mean change in body weight from baseline to week 68 was 14.9% or 34 pounds in the semaglutide group as compared with 2.4% in the placebo or about six pounds. Anthropometric measures, BMI, and cardiovascular and metabolic measures were better in the semaglutide group compared to the controls.

The results of the trial have already caused the manufacturer to apply for a rapid approval review as a weight loss drug. The question is this: is it really a game changer in the treatment for obesity? I’ll talk about that on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: NEJM. 2021. DOI: 10.1056/NEJMoa2032183

Researching GOLO’s Claims

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Before I get into the rest of the research on the claims made by GOLO, I want to be clear that I have nothing against any products or programs in the market. I’m not assessing the entire program for any company. But having worked for a couple of decades with companies that follow the FDA and FTC Guidelines for dietary supplements very closely, it’s more than frustrating when companies play loose with the research. If they make a structure-function claim, they should be able to substantiate those claims according to the guidelines.

Published Studies

The GOLO website refers to two studies that were published in journals. In the first study, a researcher assessed the effectiveness of the GOLO program on measures of weight and glycemic control. The study lasted 13 weeks; 16 out of 26 subjects completed the trial. There were significant reductions in body weight and insulin levels.

In a second study, the same researcher compared the subjects who used the GOLO weight loss program. The control group was given a placebo and the experimental group was given the program’s dietary supplement. The treatment group lost more body weight than the controls; there were also positive changes in serum insulin and a score of insulin resistance.

The implication is that in all studies, published or not, the dietary supplement made the difference in the results. There’s no way to tell. While every study talked about caloric intake, they did not report comparative data, either within subjects when there was no control group, or between groups when there was. This is simply poor research methodology and statistical analysis.

Does the Research Prove the Claim?

As I said on Thursday, while the company makes many claims on the website, I stuck to the one that said the product was “clinically proven to reduce insulin resistance.” They did not prove that the dietary supplement helped reduce insulin levels, blood glucose levels, or HOMA-IR, a measure of insulin resistance. There were just too many confounding variables they did not examine. I already made mention of the caloric intake. The program evolved over time from one where they planned a 500-calorie deficient diet for the subjects to one where they were advised on how to construct a diet from certain food selections. That’s why caloric intake is so important; we need to know that to find out how well the subjects met the dietary guidelines. The best they could claim is that the supplement may have assisted some subjects to lose weight.

In each study, the changes in HbA1c were relatively meaningless in the real world; reducing HbA1c by 0.18% and 0.61% is within the error of the method. As for the use of HOMA-IR, the researcher who developed the algorithm has said that it was not suitable for these types of clinical trials, just for large epidemiologic studies. Finally, the reduction in blood sugar in every trial where it was measured could be explained by exercise, which they also did not account for in the analysis; many people don’t realize exercise can modify insulin resistance by the third workout.

The Bottom Line

There were many more issues with the selection of data used in the multiple analyses and in the choice of statistics themselves. Most importantly, the significant loss of subjects—all four lost up to 40% of all subjects—was acknowledged by the authors, but they didn’t explain its impact. I could go on with errors, but it’s unnecessary. For the claims made, the level of substantiation is simply not sufficient to exhibit the dietary supplement’s benefit for insulin resistance. The weight loss program may be beneficial, but it can’t be verified by any of the studies they completed or by the materials provided on their website.

Eat less. Eat better. Move more. Do those long enough and you will be able to lose weight, get fit, and improve your metabolism as well.

What are you prepared to do today?

        Dr. Chet

References:
1. Diabetes Updates, 2019 doi: 10.15761/DU.1000125.
2. Trends Diabetes Metab, 2019 doi: 10.15761/TDM.1000109.

Product Claims for GOLO

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Another ubiquitous commercial on television is for a weight loss program called GOLO for Life, a dietary supplement and a weight loss program. It’s the one that uses an illustration to explain insulin resistance: the muscle in the abdominal area is blocked from using belly fat by a barrier. Insulin resistance is much more complicated than that, but I guess it makes a point. The claim in an expanded version of the commercial on the GOLO website is that “the program is clinically proven to reduce insulin resistance.” There are many more claims, but I’m going to stick with that one.

The company supported four studies on the GOLO for Life program; I’ll cover the two pilot studies today—one in the U.S. and another in South Africa—and the remainder on Saturday.

The U.S. pilot study did not have a control group, had a significant number of dropouts, and did not report the caloric intake of the subjects. The subjects lost a significant amount of weight and lowered their HbA1c by 4%.

The South African study was not so much a study as a series of GOLO programs conducted as part of wellness programs in businesses. The data were combined for analysis. Again, there were significant dropouts and caloric intake was not reported. The subjects using the supplement lost more weight than the controls.

Why did I make a big deal about caloric intake? If we don’t know how much they claimed they ate, we don’t know whether to attribute the results to the supplement or the weight loss program or both. The purpose of pilot studies is to help set up clinical trials, and we’ll take a look at those on Saturday.

What are you prepared to do today?

        Dr. Chet